A mental fog referred to as 'chemo brain' that chemotherapy patients complain about, is finally getting the attention it deserves.
Patients especially women have for years informed their doctors about cognitive symptoms such as short-term memory loss, an inability to concentrate, difficulty retrieving words, trouble with multitasking and an overarching sense that they had lost their mental edge. Once brushing such complaints aside, these very people, i.e. health professionals, are beginning to grasp the seriousness of these problems and offer treatments such as drugs used to treat attention deficit disorder and alternative therapies like acupressure.
"Until recently, oncologists would discount it, trivialize it, make patients feel it was all in their heads," says Dr. Daniel Silverman, a cancer researcher at the University of California, Los Angeles, who studies the cognitive side effects of chemotherapy. "Now there's enough literature, even if it's controversial, that not mentioning it as a possibility is either ignorant or an evasion of professional duty."
Almost all persons exposed to life saving measures like chemotherapy report short-term memory loss, difficulty concentrating etc., but the majority of them improve after a while. Yet 15 percent of these persons do not, and experts do not know why. These people go on to have typical cognitive symptoms like forgetfulness, distraction etc.
Oncologists suggest chemo brain could be due to very high doses of chemotherapy; like those before a bone marrow transplant, or the combination of chemotherapy and supplementary hormonal treatments, like tamoxifen or aromatase inhibitors that lower the amount of estrogen in women who have cancers fueled by female hormones, as well as early-onset cancer that catapults women in their 30s and 40s into menopause.
There are other suggestions got from various studies such as the discovery of a gene linked to Alzheimer's in such patients and PET scans showing unusual activity in regions of the brain governing short term recall.
Another such suggestion is the rapid onset of menopause after cancer diagnosis and chemotherapy. This fast-forward to menopause without a woman getting time to go through it naturally could be one reason to cognitive problems. Another could be that cognitive issues are the bi-products of anxiety and depression, features that follow cancer diagnosis.
Dr. Tim Ahles, one of the first American scientists to study cognitive side effects, acknowledges that studies have been too small to zero in on a cause.
"So many factors affect cognitive function, and the kinds of cognitive problems associated with cancer treatment can be caused by many other things than chemotherapy," says Dr. Ahles, the director of neurocognitive research at Memorial Sloan-Kettering Cancer Center in New York.
At the same time chemo brain is actually a testimony to the vast progress made in the field of cancer care. Persons who would not have survived long ago are now alive due to the latest drugs and treatment. Hence it is obviously a due continuation of the life-saving work of cancer therapy, to delve more into this condition of chemo brain and help find a cure or management of the condition.
"A large number of people are living long and normal lives," says Dr. Patricia Ganz, an oncologist at U.C.L.A. who is one of the nation's first specialists in the late side effects of treatment. "It's no longer enough to cure them. We have to acknowledge the potential consequences and address them early on."
Till then patients have to depend on their inner strength as well as derive comfort from humor and true stories shared between cancer survivors.
Studies of cognitive effects have overwhelmingly been conducted among breast cancer patients because they represent, by far, the largest group of cancer survivors and because they tend to be sophisticated advocates, challenging doctors and volunteering for research.